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Journal of the American College of... Jun 2019Three recent renal denervation studies in both drug-naïve and drug-treated hypertensive patients demonstrated a significant reduction of ambulatory blood pressure... (Review)
Review
Three recent renal denervation studies in both drug-naïve and drug-treated hypertensive patients demonstrated a significant reduction of ambulatory blood pressure compared with respective sham control groups. Improved trial design, selection of relevant patient cohorts, and optimized interventional procedures have likely contributed to these positive findings. However, substantial variability in the blood pressure response to renal denervation can still be observed and remains a challenging and important problem. The International Sympathetic Nervous System Summit was convened to bring together experts in both experimental and clinical medicine to discuss the current evidence base, novel developments in our understanding of neural interplay, procedural aspects, monitoring of technical success, and others. Identification of relevant trends in the field and initiation of tailored and combined experimental and clinical research efforts will help to address remaining questions and provide much-needed evidence to guide clinical use of renal denervation for hypertension treatment and other potential indications.
Topics: Blood Pressure; Blood Pressure Monitoring, Ambulatory; Congresses as Topic; Denervation; Humans; Hypertension; Internationality; Kidney; Randomized Controlled Trials as Topic; Review Literature as Topic; Sympathectomy; Sympathetic Nervous System
PubMed: 31196459
DOI: 10.1016/j.jacc.2019.04.015 -
CMAJ : Canadian Medical Association... Nov 2023
Topics: Humans; Hypertension; Kidney; Denervation; Blood Pressure; Treatment Outcome; Antihypertensive Agents
PubMed: 37931951
DOI: 10.1503/cmaj.230745 -
MMW Fortschritte Der Medizin Oct 2020
Review
Topics: Denervation; Humans; Hypertension; Kidney
PubMed: 33020881
DOI: 10.1007/s15006-020-4358-z -
Clinical Medicine (London, England) Dec 2014Renal sympathetic denervation is a novel, endovascular treatment with potential utility in resistant hypertension. First pioneered in humans in 2010, conflicting data... (Review)
Review
Renal sympathetic denervation is a novel, endovascular treatment with potential utility in resistant hypertension. First pioneered in humans in 2010, conflicting data exist regarding the efficacy of this treatment. This article will review the evidence to date, the scientific rationale for sympathetic denervation as a treatment for hypertension and consider other possible conditions where the therapy may be of benefit.
Topics: Endovascular Procedures; Humans; Hypertension; Kidney; Sympathectomy
PubMed: 25468917
DOI: 10.7861/clinmedicine.14-6-s38 -
Cardiovascular Revascularization... Sep 2022Radio frequency (RF) based percutaneous catheter renal denervation systems offer an additional clinical tool, along with lifestyle modification and drug therapy, to... (Review)
Review
Radio frequency (RF) based percutaneous catheter renal denervation systems offer an additional clinical tool, along with lifestyle modification and drug therapy, to address the global epidemic of uncontrolled hypertension. The most widely applied RF system has been designed to optimize both procedural and safety and efficacy. Lesion size, shape, and depth result from a complex interaction of device design, anatomy, and tissue electrical conduction properties. Power control algorithms must be carefully designed, incorporating feedback to maximize nerve destruction while minimizing collateral damage. Physical and numerical modelling as well as analysis of sensor feedback provide insight into design performance that cannot be derived from clinical trials. This review is focused on key design and performance aspects of the most widely applied renal denervation system meant to optimize safety and efficacy of the procedure.
Topics: Blood Pressure; Catheter Ablation; Catheters; Denervation; Electric Impedance; Humans; Hypertension; Kidney; Renal Artery; Sympathectomy; Temperature; Treatment Outcome
PubMed: 35232663
DOI: 10.1016/j.carrev.2022.02.018 -
Trends in Cardiovascular Medicine Jul 2014The autonomic nervous system is known to play a significant role in the genesis and persistence of arrhythmias. Neuromodulation has become a new therapeutic strategy for... (Review)
Review
The autonomic nervous system is known to play a significant role in the genesis and persistence of arrhythmias. Neuromodulation has become a new therapeutic strategy for the treatment of ventricular arrhythmias. Catheter-based renal denervation (RDN) is being studied as a treatment option for drug-refractory hypertension. Ablation within the renal arteries, by altering efferent and afferent signaling, has the potential to improve blood pressure, as well as heart failure, atrial, and ventricular tachyarrhythmias. We present a brief review of the anatomic and pathophysiological rationale for RDN as an adjunctive treatment for ventricular tachyarrhythmias.
Topics: Animals; Autonomic Denervation; Catheter Ablation; Heart Rate; Humans; Kidney; Tachycardia, Ventricular; Treatment Outcome
PubMed: 25017919
DOI: 10.1016/j.tcm.2014.05.006 -
Journal of the American College of... Jun 2020
Topics: Denervation; Humans; Hypertension; Kidney; Registries
PubMed: 32527397
DOI: 10.1016/j.jacc.2020.04.058 -
Hypertension Research : Official... Jul 2023Cardiometabolic disorders are associated with a substantial loss in quality of life and pose a large burden on healthcare systems worldwide. Overactivation of the... (Review)
Review
Cardiometabolic disorders are associated with a substantial loss in quality of life and pose a large burden on healthcare systems worldwide. Overactivation of the sympathetic nervous system has been shown to be a key player in several aspects relating to cardiometabolic disturbances. While diet- and exercise-induced approaches to help reduce weight remains the main strategy to combat metabolic disorders, this is often difficult to achieve. Current pharmacological approaches result in variable responses in different patient cohorts and long-term efficacy may be limited by medication side effects and non-adherence in the long term. There is a clear clinical need for complementary therapies to curb the burden of cardiometabolic disease. One such approach may include interventional sympathetic neuromodulation of organs relevant to cardiometabolic control. Data from sham-controlled clinical trials demonstrate the feasibility, safety and efficacy of catheter-based renal denervation. In analogy, denervation of the common hepatic artery is now feasible in humans and may prove to be similarly useful in modulating sympathetic overdrive directed towards the liver, pancreas and duodenum. Such a targeted multi-organ neuromodulation strategy may beneficially influence multiple aspects of the cardiometabolic disease continuum including blood pressure, glucose and lipid control.
Topics: Humans; Hypertension; Sympathectomy; Quality of Life; Kidney; Sympathetic Nervous System; Blood Pressure; Denervation
PubMed: 37088807
DOI: 10.1038/s41440-023-01287-x -
Journal of the American Heart... Feb 2024The renal sympathetic nervous system modulates systemic blood pressure, cardiac performance, and renal function. Pathological increases in renal sympathetic nerve...
BACKGROUND
The renal sympathetic nervous system modulates systemic blood pressure, cardiac performance, and renal function. Pathological increases in renal sympathetic nerve activity contribute to the pathogenesis of heart failure with preserved ejection fraction (HFpEF). We investigated the effects of renal sympathetic denervation performed at early or late stages of HFpEF progression.
METHODS AND RESULTS
Male ZSF1 obese rats were subjected to radiofrequency renal denervation (RF-RDN) or sham procedure at either 8 weeks or 20 weeks of age and assessed for cardiovascular function, exercise capacity, and cardiorenal fibrosis. Renal norepinephrine and renal nerve tyrosine hydroxylase staining were performed to quantify denervation following RF-RDN. In addition, renal injury, oxidative stress, inflammation, and profibrotic biomarkers were evaluated to determine pathways associated with RDN. RF-RDN significantly reduced renal norepinephrine and tyrosine hydroxylase content in both study cohorts. RF-RDN therapy performed at 8 weeks of age attenuated cardiac dysfunction, reduced cardiorenal fibrosis, and improved endothelial-dependent vascular reactivity. These improvements were associated with reductions in renal injury markers, expression of renal NLR family pyrin domain containing 3/interleukin 1β, and expression of profibrotic mediators. RF-RDN failed to exert beneficial effects when administered in the 20-week-old HFpEF cohort.
CONCLUSIONS
Our data demonstrate that early RF-RDN therapy protects against HFpEF disease progression in part due to the attenuation of renal fibrosis and inflammation. In contrast, the renoprotective and left ventricular functional improvements were lost when RF-RDN was performed in later HFpEF progression. These results suggest that RDN may be a viable treatment option for HFpEF during the early stages of this systemic inflammatory disease.
Topics: Humans; Male; Rats; Animals; Heart Failure; Stroke Volume; Tyrosine 3-Monooxygenase; Kidney; Sympathectomy; Inflammation; Norepinephrine; Fibrosis; Denervation
PubMed: 38353216
DOI: 10.1161/JAHA.123.032646 -
Physiological Reports May 2023Skeletal muscle is a highly pliable tissue and various adaptations such as muscle hypertrophy or atrophy are induced by overloading or disuse, respectively. However, the...
Skeletal muscle is a highly pliable tissue and various adaptations such as muscle hypertrophy or atrophy are induced by overloading or disuse, respectively. However, the combined effect of overloading and disuse on the quantitative adaptation of skeletal muscle is unknown. Thus, the aim of this study was to investigate the effects of the combined stimuli of overloading and disuse on mouse skeletal muscle mass and the expression of regulatory factors for muscle protein anabolism or catabolism. Male mice from the Institute Cancer Research were subjected to denervation concomitant with unilateral functional overload or functional overload concomitant with unilateral denervation. Disuse and functional overload were induced by sciatic nerve transection (denervation) and synergist ablation, respectively, and the plantaris muscle was harvested 14 days after the operation. Our results showed that denervation attenuated functional overload-induced muscle hypertrophy and functional overload partially ameliorated the denervation-induced muscle atrophy. P70S6K phosphorylation, an indicator of mechanistic target of rapamycin complex 1 (mTORC1) activation, was not increased by unilateral functional overload in denervated muscles or by unilateral denervation in functional overloaded muscles. Denervation did not affect the increase of LC3-II, a marker of autophagy activation, and ubiquitinated protein expression upon unilateral functional overload. Also, functional overload did not affect ubiquitinated protein expression during unilateral denervation. Thus, our findings suggest that functional overload-induced muscle hypertrophy or denervation-induced muscle atrophy was attenuated by the combined stimuli of overload and denervation.
Topics: Male; Animals; Mice; Muscle, Skeletal; Transcription Factors; Muscular Atrophy; Denervation; Hypertrophy
PubMed: 37161590
DOI: 10.14814/phy2.15689